The Experimental Sgudy on Payment System for Reimbursement to Medical Institutions

英美两国医疗机构报销支付制度改革的方向是，采用按服务收费支付制度（FFS）的美国引入前瞻性支付制度（PPS），采用按服务收费支付制度（PPS）的英国引入FFS。两国努力寻找一套充分结合了这两种类型的方法。如果医疗机构以利润最大化为动机，对支付系统运作的理论验证表明，PPS可能导致治疗供应不足，FFS可能导致治疗供应过剩。通过计量经济学的方法验证了补偿变更的效果。但由于医学数据收集的困难，并不能给出准确的结论。我们用实验经济学的方法来验证理论结果，而不需要现有的数据。在假设医疗机构利润最大化的实验中，不会产生供过于求。对实验数据的统计检验表明，大多数医疗机构主体更关心患者的利益，而不是自身的利益。从我们的实验结果来看，我们可以预期PPS的引入不会导致治疗的急剧下降。由于上述实验所使用的理论模型无法实现患者对医疗机构的选择，我们将其扩展为动态模型，患者可以自由选择医疗机构。主要结果如下。从FFS转为PPS后，医疗支出大幅下降。但随着选择的进展，它与FFS下的医疗支出趋同。基于实验经济学方法的计算机网络系统对这一结果进行了检验。实验验证了理论结果的有效性。即在患者就诊的医疗机构的治疗情况和平均治疗情况已知的情况下，患者根据两者的差异自行选择，使PPS下的治疗均等化。现在，我们正在写一篇关于这个结果的文章。少

The reform of payment system for reimbursement to medical institutions in U.K. and U.S. carries on in the direction where U.S. with fee-for-service payment system (FFS) introduced prospective payment system (PPS) and U.K. with PPS introduced FFS. The two countries efforts to search for a set combined adequately two kinds of these. If medical institution is motivated to maximize their profits, the theoretical verification about workings of the payment system has the result that PPS may causes the under-supply of treatments and FFS causes the over-supply.Empirical studies about effect which the reimbursement was changed is verified by econometric method. But precise conclusions are not given by difficulty of medical data collection. We verify the theoretical result by the method of experimental economics that does not need existing data. In the experiment assuming the profit maximization in the medical institution, the over-supply was not caused. Statistical testing to our experimental d … More ata suggests that most of medical institution subject concerned more for patient subject's benefits than for their self-profits. Judging from the result of our experiments, we can expect that the introduction of PPS does not cause drastic fall in treatments.Because the medical institution selection by patients was impossible in the theory model used by the above-mentioned experiment, we expanded it to a dynamic model, which patients can be free to select a medical institution. The main result is the following. Medical expenditures fell greatly just after switching from FFS to PPS. But it converges in almost the same as medical expenditures under FFS with progress of the selection.This result is examined by the computer network system based on the method of experimental economics. This experiment demonstrates the validity of theoretical result. That is, when the treatment of the medical institution visited by patients and the average treatment were already known, the result to equalize the treatment under PPS by the patient's free selection based on the discrepancy between the two. Now, we are making an articles about this result. Less